Strabismus is the condition, in which the eyes are not properly aligned. Strabismus can afflict all age groups and its onset can be sudden or gradual. The misalignment of the eyes could be present at all times, but it can occur intermittently such as with near visual tasks, looking only in certain directions, or during time of fatigue or inattention. Adults with strabismus frequently present with complaint of double vision, unless they have had strabismus since childhood.

There are six muscles in each eye socket that control the movement of the eye. Strabismus can occur due to weakness, over-action, scarring, inflammation, or entrapment of any of theses muscles that control eye movement. Common conditions that cause strabismsus include thyroid eye disease, trauma, stroke, diabetes mellitus, myasthenia gravis, and brain aneurysms. In many cases, strabismus could be the first sign of the onset of disease. In some cases, the development of strabismus could be due to longstanding decreased vision in one eye (such as dense cataract). In many patients, whose eyes have a tendency to drift since childh, develops strabismus later in life when the brain can no longer keep the eyes aligned all the time, especially when patient is tired. The ocular misalignment can also vary depending on the direction of gaze or whether patient is focusing far or near

The diagnosis of the underlying cause of strabismus can be complex and it requires the expertise of a strabismus specialist. A careful complete eye examination is a must. Correct diagnosis is crucial because the treatment of strabismus differs from cases to case depending on its underlying cause. If an underlying disorder is suspected, clinical tests and imaging studies (CT or MRI scans) are performed, usually in consultation with patient’s primary care physician. On rare occasion, a timely diagnosis can save the strabismus patient’s life, such as in cases of myasthenia gravis and brain aneurysms.

If patient has a systemic disorder, e.g., stroke or myasthenia gravis, that is causing ocular misalignment, then the underlying condition must be treated first. If the misalignment is correctable with glasses, the proper spectacles with prisms are prescribed. If there is inflammation of eye muscles such as in thyroid eye disease (i.e., Grave’s disease), short-term oral steroid therapy might be indicated. Surgery of the eye muscles is frequently needed to re-establish the proper ocular alignment. Adult strabismus surgery is usually performed outpatient and involves weakening and strengthening certain eye muscle groups in order to re-establish proper ocular alignment. Depending on the case, the surgeon may operate on either one eye or both eyes. In cases of strabismus due to muscle weakness or paralysis, Botox is sometimes used to lessen the amount of ocular misalignment.

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